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Rob Krar is a decorated professional ultramarathoner, setting records and notching victories at 50- and 100-mile races around the world. Still, the 41-year-old Hamilton, Ont., native sometimes finds himself at the threshold of his Flagstaff, Ariz., home, dressed for a run but unable to step through the door.

“I don’t have that magic wand to wave and get myself out of it,” he says. “Sometimes I can and sometimes I can’t.”

Getting out the door is important – not just because it's Krar's job, but also because he struggles with depression, a condition that will afflict somewhere between 10 and 20 per cent of people (depending on the diagnostic criteria you use) at some point in their lives. For Krar and many others, running plays a unique and poorly understood role in helping them manage their mental health, according to a new book by Scott Douglas called Running is My Therapy: Relieve Stress and Anxiety, Fight Depression, Ditch Bad Habits, and Live Happier.

Douglas, a long-time Runner’s World editor (where he was a colleague of mine) and lifelong runner, has struggled with dysthymia, a form of chronic, low-grade depression, since he was a teenager. He had long known that his daily runs provided a crucial mood boost, but in writing the book he set out to discover if there was a deeper and more lasting connection between his hobby and his depression.

“Are the mental health benefits of running transitory, so that every day you’re Sisyphus starting from scratch?” he wondered. “Or is there a cumulative effect from regular running, so that your set point gets raised? I was sort of amazed I didn’t already know the answer.”

As Douglas learned, there’s solid evidence that over time, regular running does indeed produce two of the key changes thought to explain the effects of antidepressant drugs. First, it increases levels of crucial mood-related brain chemicals such as serotonin and noradrenaline; and second, it stimulates the formation of new neurons, particularly in the hippocampus, a brain region that is often shrunken in people with depression.

That finding helps explain why numerous studies have found that exercise is just as effective as medication for mild to moderate depression – an insight that remains underappreciated in medical circles, Douglas believes.

In this respect, Canadian guidelines, which recommend exercise as a first-line treatment for mild to moderate depression, are ahead of their American equivalents. But Australia and New Zealand take it a step further, prescribing exercise as a “step-zero” treatment that sedentary depressed patients are encouraged to try before doctors consider medication or psychotherapy.

Science has no firm answers about whether running is uniquely effective at fighting depression compared to other forms of exercise, Douglas acknowledges. But there are some intriguing hints.

If you run at least a few times a week, it’s relatively easy to reach and sustain the moderate, conversational intensity that studies have found most effectively triggers mood-boosting brain chemicals. Your intensity isn’t at the mercy of hills and traffic lights, as it may be while cycling, and requires very little technique to master, unlike swimming and cross-country skiing.

There’s also a social aspect – and the logistics of running with friends while side-by-side, eyes ahead, may encourage more open conversations, Sepideh Saremi, a California-based psychotherapist who conducts on-the-run therapy sessions, tells Douglas. That’s why parents often get the most honest information from their teens while driving in the car, she explains.

Ultimately, while the mental-health benefits of running are firmly established, the details remain scantily researched. Does running alter the ideal dosage of antidepressant drugs, perhaps due to changes in blood flow, as a University of Toronto study suggested a few years ago? Do some antidepressants or forms of talk therapy combine better with running than others? Is there an ideal length, pace or time of day to run?

In the absence of peer-reviewed certainty, Douglas shares the diverse experiences of numerous runners who have found their own approaches for using running to help manage depression or anxiety. It’s neither an instant not a permanent fix for any of them, but all of them share the belief that, details aside, any run is better than no run.

That’s an insight that Krar, too, works hard to internalize – even on the inevitable bad days.

“Now I’m more willing to say, ‘Okay, I’m not going to be able to do that fifteen-miler or track workout,” he tells Douglas, “But I’m going to get my ass out the door for a four-miler.”

Alex Hutchinson is the author of Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance.

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